Repair of anorectal mucosa in fourth degree obstetric anal sphincter injury: A case series with a continuous, non-locking and sequentially knotted suturing method (onyeka suturing technique).

Abstract

Background: Appropriate repair of the torn anorectal mucosa in fourth degree perineal tears restores anorectal mucosa integrity and mitigates against potential morbidity and litigation from this complication. However, there is a lack of evidence to guide practice in relation to the repair of the anorectal mucosa. A haemostatic suturing technique previously used to facilitate same day pelvic floor repair without overnight vaginal packing was thought to be optimally placed as an alternative. Our aim was to introduce a continuous, non-locking and sequentially knotted suturing method (the Onyeka haemostatic suturing technique) in the repair of torn anorectal mucosa in fourth degree perineal tears. Method(s): A retrospective case series of 5 consecutive fourth degree perineal tear repairs performed at a secondary level hospital in which the torn anorectal mucosa was repaired with the Onyeka suturing method. All patients were initially reviewed at 6 weeks following the repair by the primary surgeon and then further independent telephone review took place between 10-12 months post operatively. Result(s): All patients were satisfied with their repair and there were no reported complications of readmission, infection, wound break down, tissue necrosis, perineal pain, dyspareunia, fistula formation, flatal or faecal incontinence. Discussion(s): In an area where there is paucity of evidence, obstetricians should report their experiences in this area to better inform decision making. The Onyeka suturing technique can be considered as an alternative technique to traditional consensus based techniques as it appears to be a safe and effective method of anal mucosa repair.